<Insert Name of In-patient Facility> Emergency Operations Plan Guidance <Insert Date Template is Completed/Revised> 1
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
<Insert Name of In-patient Facility>
Emergency Operations Plan Guidance<Insert Date Template is Completed/Revised>
1
Instructions for guidance use:
This template document offers emergency operations planning guidance that can be customized for use by Louisiana inpatient facilities including hospitals; intermediate care facilities for individuals with intellectual disabilities; long term care; psychiatric residential treatment facilities and transplant centers.
2
Facility Profile
Facility Name:
Address:
Parish:
Phone: Fax:
Emergency Phone:
Email Address:
Facility CEO/ Administrator:
Address:
Phone: Secondary Phone:
Emergency Phone:
Emergency Operations Plan Coordinator:Address:
Phone: Secondary Phone:Emergency Phone:
Table 1Primary and Affiliate/Sister Facilities (See Attachment E)
Primary Facility Facility Name Address (Street, Parish Contact Number
3
City, State, Zip)
Affiliate/Sister Facilities (Include specific information in Attachment E.)
Facility Name Address (Street, City, State, Zip) Parish Contact Number
4
Signature Page
<Insert Facility Name>
______________________________________ _________________Name, Title Date
______________________________________ _________________Name, Title Date
5
Record of Changes
This is a continuing record of all changes to the EOP.
Change Number
Date of Change Description of Change Initials
6
Record of Distribution This plan has been provided to the following personnel and/or agencies.
Recipient Name Department/Agency Date Distributed Initials
Table of Contents
7
Facility Profile.......................................................................................................................3
Signature Page.....................................................................................................................5
Record of Changes...............................................................................................................6
Record of Distribution..........................................................................................................7
1. INTRODUCTION...........................................................................................................11
A. Purpose..................................................................................................................11
B. Scope.....................................................................................................................12
C. Planning Assumptions............................................................................................12
2. ADMINISTRATION.......................................................................................................13A. Executive Summary...............................................................................................13
B. Plan Review and Maintenance...............................................................................13
C. Authorities and References....................................................................................14
3. SITUATION...................................................................................................................15Risk Assessment ..........................................................................................................15
4. CONCEPT OF OPERATIONS......................................................................................16A. Incident Management.............................................................................................16
B. Plan Activation........................................................................................................16
5. ROLES AND RESPONSIBILITIES...............................................................................18A. Essential Services..................................................................................................18
B. Positions.................................................................................................................18
6. COMMAND AND COORDINATION..............................................................................19A. Command Structure...............................................................................................19
B. Local Emergency Operations Center Coordination................................................22
7. RESOURCES AND ASSETS........................................................................................23A. Acquiring and Replenishing Medications and Supplies.........................................23
B. Sharing Resources with Other Healthcare Organizations......................................23
C. Monitoring Quantities of Resources and Assets....................................................24
D. Resource Sustainability..........................................................................................24
8. MANAGEMENT OF STAFF..........................................................................................25A. Assignment of Staff................................................................................................25
B. Managing Staff Support Needs..............................................................................25
C. Volunteer Needs.....................................................................................................25
8
9. PATIENT MANAGEMENT IN AN EMERGENCY.........................................................26A. Patient Scheduling, Triage/Assessment, Treatment, Transfer, and Discharge......26
B. Vulnerable Populations..........................................................................................26
C. Management of Behavioral Health Patients...........................................................26
D. Behavioral Health Services to Patients……………………………………………….26
E. Patient Tracking......................................................................................................27
10. UTILITIES AND SUPPLIES………………………………………………………………...28
A. Power.....................................................................................................................28
B. Water......................................................................................................................29
C. Medical Gas/Vacuum Systems...............................................................................31
11. OTHER CRITICAL UTILITIES......................................................................................33Maintenance Activities...................................................................................................33
12. EVACUATION...............................................................................................................34A. Decision Making: Evacuate or Shelter-in-Place.....................................................34
B. Transportation Resources......................................................................................34
C. Patient Records and Maintenance.........................................................................35
D. Patient Provisions/Personal Effects.......................................................................36
E. Evacuation Locations.............................................................................................36
F. Evacuation Routes.................................................................................................38
G. Evacuation Priorities...............................................................................................38
H. Securing Equipment...............................................................................................38
I. Securing Vital Records...........................................................................................38
13. RECOVERY..................................................................................................................39A. Initiation and Recovery...........................................................................................39
B. Protocol..................................................................................................................39
C. Restoration of Services..........................................................................................39
D. Utility Restoration...................................................................................................40
E. Staff/Patient Re-Entry.............................................................................................40
F. Staff Debriefing.......................................................................................................40
G. After-Action Report/Improvement Plan..................................................................40
14. GLOSSARY..................................................................................................................4115. ACRONYMS.................................................................................................................45
9
16. ATTACHMENTS............................................................................................................47A. Training Plan..........................................................................................................49
B. Excercises………………………………………………………………………………….50
C.. Mutual Aid Agreements/Memoranda of Understanding..........................................51
D. Sample Hospital Incident Command System Forms..............................................52
E. Affiliated Facilities Specific Information………………..……………...……………..53
17. ANNEXES.....................................................................................................................54A. Communications.....................................................................................................56
B. Safety and Security................................................................................................68
C. Continuity of Operations.........................................................................................70
D. Hazard Vulnerability Analysis and Example Hazard Threat Response Plan………………………………………………………………………………………..78
E. Louisiana Volunteers In Action………………………………………………………... 81
18. INCIDENT SPECIFIC APPENDICES............................................................................82A. Active Shooter........................................................................................................83
B. Biological Event......................................................................................................84
C. Bomb Threat...........................................................................................................85
D. Chemical Event......................................................................................................86
E. Cyber Attack...........................................................................................................87
F. Earthquake.............................................................................................................88
G. Explosive Event......................................................................................................89
H. Extended Power Outages......................................................................................91
I. Fire.........................................................................................................................92
J. Floods.....................................................................................................................93
K. Hazardous Materials and Decontamination...........................................................94
L. Hurricanes..............................................................................................................95
M. Nuclear/Radioactive Event.....................................................................................96
N. Pandemic Influenza/Infection Control/Isolation......................................................97
O. Severe Weather/Extreme Temperatures/Winter Storms........................................98
P. Surge Capacity.....................................................................................................100
Q. Wildfire.................................................................................................................101
10
1. INTRODUCTION
A. Purpose
The purpose of the <In-patient Facility Name> Emergency Operations Plan (EOP) is to establish a basic emergency program to provide timely, integrated, and coordinated response to the wide range of natural and manmade events that may disrupt normal operations and require pre-planned response to internal and external incidents.
The objectives of the emergency management program include:• To provide maximum safety and protection from injury for patients, visitors, and staff.• To attend promptly and efficiently to all individuals requiring medical attention in an
emergency situation.• To provide a logical and flexible chain of command to enable maximum use of
resources.• To maintain and restore essential services as quickly as possible following an
incident.• To protect hospital property, facilities, and equipment.• To satisfy all applicable regulatory and accreditation requirements.
Particular attention shall be given to critical areas of concern which may arise during any “all hazards” emergency whether required to evacuate or to shelter in place. The six (6) critical areas of consideration are:
Communications. Resources and assets Safety and security Staffing Utilities Clinical Activities
Regulatory and Center for Medicare and Medicaid Services require emergency planning for:
Alternate care site Transportation Communications Continuity of operations Evacuation Continuity of Operations Coordination Policies and procedures Risk Assessment / Hazard Vulnerability Analysis Incident specific procedures Training and exercise plans
11
B. Scope
The Emergency Operations Plan (EOP) is designed to guide planning and response to a variety of hazards that could threaten the environment of the inpatient facility or the safety of patients, staff and visitors, or adversely impact the facility’s ability to provide healthcare services to the community. The “all hazards” plan is also designed to meet local and state planning requirements.
Authority for activating the plan will rest with the <Insert position title>. Activation of the plan will be conducted in conjunction with agency command staff as well as local emergency management and public health personnel.
C. Planning Assumptions
The following assumptions delineate what is assumed to be true when the EOP was developed. The assumptions statement also shows the limits of the EOP.
Identify/list the top five hazards and/or threats found in the facility hazard vulnerability analysis (HVA) – see Annex D. Hazard Vulnerability Analysis, Attachment 1.
Identify priority community threats and hazards found in a community HVA – see Annex D. Hazard Vulnerability Analysis, Attachment 2.
Identified hazards will occur. Healthcare personnel are familiar with the EOP. Healthcare personnel will execute their assigned responsibilities. Executing the EOP will save lives and reduce damage.
12
2. ADMINISTRATION
A. Executive Summary
The <Insert name of facility> Emergency Operations Plan (EOP) is an all-hazards plan that outlines policies and procedures for preparing for, responding to, and recovering from possible hazards faced by the organization. The plan is based on priority hazards and threats identified in the facility’s risk assessment or hazard vulnerability analysis (HVA) and considers implications of a community risk assessment. Coordination of planning and response with other healthcare organizations, public health, and local emergency management are emphasized in the plan. The plan also addresses proper plan maintenance, communications, resource and asset management, patient care, continuity of operations, management of staff, evacuation, and contingency planning for utilities failure.
The plan will undergo an annual review process to ensure any plan deficiencies are identified and addressed. An improvement plan will be instituted and maintained in the plan to ensure lessons learned and action items identified from exercises and real events are properly addressed and documented.
All response activities will follow the National Incident Management System (NIMS) approach, including use of the Incident Command System (ICS). The facility will follow the Incident Command System (ICS) organizational structure in response to emergency events and in exercises. The Hospital Incident Command System (HICS) is an example of ICS implementation for hospitals and healthcare systems. In the event of a communitywide emergency, the facility’s incident command structure will be integrated into and be consistent with the community command structure. Staff is encouraged to receive training in the ICS system and in assigned roles and responsibilities to ensure they are prepared to meet the needs of patients in an emergency. See attachment A Training Plan.
B. Plan Review and Maintenance
Plan Review
The EOP will be reviewed and updated annually incorporating: the latest NIMS implementation activities and data collected during actual and exercise plan activations, changes in the hazard vulnerability analysis, changes in emergency equipment, changes in external agency participation, etc.
Plan review should also consider changes in contact information, new communications with the local parish Office of Homeland Security and Emergency Preparedness (OHSEP), review of evacuation routes and alternate care sites, and staff and departmental assignments. The review will be conducted by <Insert position title or group>. Plan updates will be the responsibility of <Insert position title>.
13
C. Authorities and References
<Insert title and date of local city and/or parish Emergency Operations Plan >
<Insert titles of other organizational plans or policies that have a connection to the Emergency Operations Plan>
Louisiana Governor’s Office of Homeland Security and Emergency Preparednesshttp://gohsep.la.gov/
Louisiana Health Standards – Hospital Licensing Standards, Hospital Emergency Preparedness Rule 9335 http://dhh.louisiana.gov/assets/medicaid/hss/docs/HSS_Hospital/Regulations/hospital_Lic_stdrds_11202003.pdf
FEMA, National Incident Management System (NIMS)http://www.fema.gov/emergency/nims/
FEMA, Incident Command System (ICS) https://www.fema.gov/incident-command-system-resources
The Joint Commissionwww.jointcommission.org
Louisiana Volunteers in Action (LAVA) https://www.lava.dhh.louisiana.gov/
Louisiana ESF8 Portal https://esf8.dhh.la.gov/esf8porta l
Centers for Medicare & Medicaid Services (CMS) http://www.cms.gov
Centers for Medicare & Medicaid Services; Emergency Preparedness Rule (2016) https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html
Disaster Resiliency and NFPA Codes and Standards Refer to the National Fire Protection Association (NFPA) Standards in NFPA 101 Life Safety Code, and NFPA 1600, Disaster/Emergency Management and Business Continuity Programs
CDC Emergency Water Supply Planning Guide Table 6-4.1http://www.cdc.gov/healthywater/pdf/emergency/emergency-water-supply-planning-guide.pdf
14
3. SITUATION
Risk Assessment
A facility risk assessment or hazard vulnerability analysis (HVA) conducted by <Insert name of entity> provides details on local hazards including type, effects, impacts, risk, capabilities, and other related data.
Facility and Community HVAs are located in Attachment 1 and 2 of the Hazard Vulnerability Analysis “Annex D”, page 78 and 79.
<Insert the top five hazards and/or threats identified in the facility HVA>
1.2.3.4.5.
Strategies to address facility hazards and/or threats are found in the incident specific appendices. (Facilities should include their plans to address priority threats/hazards and insert in Annex D).
15
4. CONCEPT OF OPERATIONS
A. Incident Management
Incident management activities are divided into four phases: mitigation, preparedness, response, and recovery. These four phases are described below:
Mitigation: Mitigation activities are those that eliminate or reduce the possibility of a disaster occurring. For healthcare operations, this may include installing generators for backup power, installing hurricane shutters and raising electrical panels to protect them from possible flood damage. <Insert Facility strategies for mitigation>
Preparedness: Preparedness activities develop the response capabilities that are needed in the event an emergency occurs. These activities may include developing emergency operations plans and procedures, conducting training for personnel in those procedures, and conducting exercises with staff to ensure they are capable of implementing response procedures when necessary. <Insert Facility strategies for preparedness>
Response: Response includes those actions that are taken when a disruption or emergency occurs. It encompasses the activities that address the short-term, direct effects of an incident. Response activities in the healthcare setting can include activating emergency plans and triaging and treating patients who have been affected by an incident. <Insert Facility strategies for response>
Recovery: Recovery focuses on restoring operations to a normal or improved state of affairs. It occurs after the stabilization and recovery of essential functions. Examples of recovery activities include: the restoration of non-vital functions, replacement of damaged equipment, facility repairs, organized return of patients into the facility, and reconstitution of patient records and other vital information systems. Another key consideration in the recovery and response phases of an incident is the tracking of staff hours, expenses, and damages incurred as a result of the emergency. Detailed records will need to be maintained throughout an emergency to document expenses and damages for possible reimbursement or to properly file insurance claims. <Insert Facility strategies for recovery>
B. Plan Activation
The Emergency Operations Plan will be activated in response to internal or external threats to the facility. Internal threats could include fire, bomb threat, loss of power or other infrastructure, or other incidents that threaten the well-being of patients, staff, and/or the facility itself. External threats include events that may not affect the facility directly but have the potential to overwhelm facility resources or put the facility on alert.
16
Persons Responsible for Plan Activation
When a threat is suspected or has been identified the employee obtaining the information must notify their supervisor immediately. If the employee cannot contact their supervisor, they must immediately contact the <Insert position title> directly.
The supervisor should in turn contact the <Insert position title>. The <Insert position title> will assess and confirm the situation and initiate the plan if necessary.
The following individuals have the authority to activate the Emergency Operations Plan:
Table 3
Individuals Responsible for Emergency Operations Plan ActivationName Contact Number
Primary:Backup 1:Backup 2:
Alerting Staff (On and Off Duty)
To notify staff that the Emergency Operations Plan has been activated, those within the facility will be contacted first through the <Insert internal communication system (e.g., overhead paging system, email, radio, etc.)>.
Staff away from the facility at the time of activation will be contacted by <Insert external communication system (e.g., phone tree, radio, media)>. The individuals responsible for contacting staff include the <Insert position title (e.g., dispatcher, supervisors)>.
Alerting Response Partners
The facility works closely with several external partners (See Annex A: Communications). The <Insert position title> will be the individual responsible for contacting these external agencies to notify them that the Emergency Operations Plan has been activated.
17
5. ROLES AND RESPONSIBILITIES
During an emergency response event, specific roles and responsibilities will be assigned to individual positions/titles as well as facility departments as required by the Incident Commander and the Incident Action Plan.
A. Essential Services
The table below identifies potential departmental roles and responsibilities during plan activation.
Table 4Roles and Responsibilities
Essential Services Roles and Responsibilities Point of Contact
Secondary Point of Contact
Administration
Dietary
Housekeeping
Maintenance
Nursing
Pharmacy
Safety & Security(Add additional essential services if needed)
B. Positions
Identifying and assigning personnel in the Incident Command System or Hospital Incident Command System (HICS) depends a great deal on the size and scope or complexity of the incident. The HICS is designed to be flexible enough so that the number of staff needed to respond to an incident can be easily expanded or contracted. HICS Form 203 is used to document and assign staff to HICS specific positions. See sample HICS forms in Attachment D.
18
6. COMMAND AND COORDINATION
A. Command Structure
Command or Incident Management will be organized following ICS and according to the Hospital Incident Command System (HICS). The chart on the next page illustrates potential structure of response activities that may be activated by the Incident Commander under the HICS. Roles are activated based on the needs, scope and scale of the event. The chart shows the chain of command and the span of control under each level of management. It also illustrates the flexibility of HICS to expand or contract response activities based on the type and size of the event.
19
Organizational Chart
Incident Commander
Public Information Officer
Liaison Officer
Safety Officer
Medical/Technical Specialist
Biological/Infectious Disease Chemical Radiological Clinic Administration Hospital Administration Legal Affairs Risk Management Medical Staff Pediatric
Operations Section Chief
Staging Manager Personnel Vehicle Equipment/Supply Medication
Medical Care Branch Director Inpatient Outpatient Casualty Care Clinical Support Services Patient Registration
Infrastructure Branch Director Power/Lighting Water/Sewer HVAC Building/Grounds Damage Medical Gases Medical Devices Environmental Services Food Services
HazMat Branch Director Detection and Monitoring Spill Response Victim Decontamination Facility/Equipment Interface
Security Branch Director Access Control Crowd Control Traffic Control Search Law Enforcement Interface
Business Continuity Branch Director Information Technology Service Continuity Records Preservation Business Function Relocation
Planning Section Chief
Resource Unit Leader Personnel Tracking Material Tracking
Situation Unit Leader Patient Tracking Bed Tracking
Documentation Unit Leader Demobilization Unit Leader
Logistics Sections Chief
Service Branch Director Communications Unit IT/IS Unit Staff Food & Water Unit
Support Branch Director Employee Health & Well-being Unit Family Care Unit Supply Unit Facilities Unit Transportation Unit Labor Pool & Credentialing Unit
Finance/Administration Section Chief
Time Unit Leader Procurement Unit Leader Compensation/Claims Unit
Leader Cost Unit Leader
20
Orders of Succession
Orders of succession ensure leadership is maintained throughout the facility during an event when key personnel are unavailable. Succession will follow facility policies for the key facility personnel and leadership.
Table 5Key Personnel and Orders of Succession
Command and Control Primary Successor 1 Successor 2
Shift 1Incident CommanderPublic Information OfficerSafety Officer
LiaisonOperations Section ChiefPlanning Section Chief
Logistics Section ChiefFinance/Administration Section ChiefShift 2Incident CommanderPublic Information OfficerSafety Officer
LiaisonOperations Section ChiefPlanning Section Chief
Logistics Section ChiefFinance/Administration Section Chief
21
Delegation of Authority
Delegations of authority specify who is authorized to make decisions or act on behalf of facility leadership and personnel if they are away or unavailable during an emergency. Delegation of authority planning involves the following:
Identifying which authorities can and should be delegated Describing the circumstances under which the delegation would be exercised
and including when it would become effective and terminate Identifying limitations of the delegation Documenting to whom authority should be delegated Ensuring designees are trained to perform the emergency duties
Table 6Delegation of Authority
Authority Type of Authority
Position Holding Authority
Triggering Conditions
Close facility Emergency Authority
Senior Leadership When conditions make coming to or remaining in the facility unsafe
Represent facility when engaging Govt. Officials
Administrative Authority
Senior Leadership When the pre-identified is not available
Activate facility memorandum of understanding/mutual aid agreements
Administrative Authority
Senior Leadership When the pre-identified leadership is not available
Add additional authorities as needed
B. Local Emergency Operations Center (EOC) Coordination
This organization will coordinate fully with the <Insert name of local Parish OHSEP>, follow the prescribed Incident Command System, and integrate fully with community agencies in activation for a disaster event or during exercises. In addition, the facility will be prepared to provide the following information: Facility occupancies needs, and a list of essential services and resources the facility can provide. The facility is encouraged to participate in their regional healthcare coalition and local emergency planning committee (LEPC).
22
7. RESOURCES AND ASSETS
A. Acquiring and Replenishing Medications and Supplies
The amounts and locations of current pharmaceuticals, medical and non-medical supplies, food and water are evaluated to determine how many hours the facility can sustain itself before needing re-supply. This gives the facility a par value on supplies and aids in the projection of sustainability before terminating services or evacuating if needed supplies are unable to reach the facility.
Supplying the inpatient facility in an emergency will be initially satisfied by pulling from local resources. As replenishment becomes necessary, resources will be requested from vendors. A list containing the names and contact information of the vendors that deliver and/or manufacture supplies and provide critical services can be found in Annex A: Communications Plan.
If the inpatient facility is unable to acquire sufficient resources through outside vendors and pre-positioned arrangements to meet the healthcare needs of the community, the <Insert position title> will communicate this need to the <Insert name of local OHSEP> to help locate resources and replenishments.
B. Sharing Resources with Other Healthcare Organizations
Include procedure for sharing or borrowing supplies within the inpatient facility network, if applicable.
If the healthcare organizations sharing the resources are within <Insert name of Parish>, a Resource Accounting Record form (HICS Form 257) should be used to document the borrowed or loaned products. See sample HICS forms in Attachment D. The equipment should then be returned after use. Any consumable supplies that are used should be billed via invoice and paid by the organization using the supplies. Any unused consumables should be returned.
Include other procedures, if applicable.
If the items shared or borrowed come from outside <Insert name of Parish>, the request should be coordinated through the <insert name of Parish Office of Homeland Security and Emergency Preparedness>. The facility should document the final location of the supplies and the quantity and type of items transported. The need must be demonstrated to exceed that of the local jurisdiction prior to disbursement of supplies or equipment.
Include other procedures, if applicable.
23
C. Monitoring Quantities of Resources and Assets
The <Insert position title> is responsible for monitoring quantities of assets and resources during an emergency. A Resource Accounting Record form (HICS Form 257) should be used when resources and assets are tracked during an emergency. See sample HICS forms in Attachment D.
List other inventory tracking systems, if applicable.
D. Resource Sustainability
Establishing the sustainability of resources is crucial to determining if services can be rendered during a disaster for three total days, based on the facility’s hazard vulnerability analysis (HVA). Resource inventory is currently maintained to provide for approximately <Insert number of hours/days>. If this cannot be sustained through current inventory, agreements are in place with suppliers and vendors for the remaining days. If supplies cannot be obtained, policies and procedures are in place in the event the facility may need to evacuate or temporarily close.
Agreements can be found in Attachment B: Mutual Aid Agreements/Memorandum of Understanding Table 16, if applicable
24
8. MANAGEMENT OF STAFF
A. Assignment of Staff
In a disaster, personnel may not necessarily be assigned to their regular duties or their normal supervisor. They may be asked to perform various jobs that are vital to the operation but may not be their normal day to day duties. The designated reporting location for staff and volunteers will be <Insert reporting location>. The <Insert position title> will delegate assignments based on communication with the Inpatient Facility Command Center. Staff will be assigned as needed and provided information outlining their job responsibilities and who they report to.
<Insert Facility Policy/Reference>
B. Managing Staff Support Needs
In some circumstances, it may be necessary to provide housing and/or transportation for staff that might not otherwise be able to perform their critical functions for the inpatient facility. These staff support functions will be coordinated through the <Insert position title>.
Housing for staff and staff family will be located at:
<Insert housing options and include addresses for staff and staff family>
Identified resources for transportation of staff and staff family include:
<Insert transportation resources and include addresses for staff and staff family>
Disasters can create considerable stress for those providing medical care. The <Insert position title> will coordinate the provision of mental health support including incident stress debriefings for staff with:
<Insert name of department(s) and/or organizations (e.g., social workers, chaplains, community mental health service organizations)>
<Insert contact information for each department/organization listed>
C. Volunteer Needs
<Insert or reference facility’s policy for credentialing, assigning to tasks, Just in Time Training, feeding, and housing volunteers>
Volunteer contact list can be found in Annex A: Communications, Attachment 1, Table 3.
9. PATIENT MANAGEMENT IN AN EMERGENCY
25
A. Patient Scheduling, Triage/Assessment, Treatment, Transfer, and Discharge
In the event of an emergency affecting the facility, the <Insert position title and/or department(s)> will assess staffing and facility capacity. Additional staff may be called upon to assist in managing the anticipated number of cases. The medical staff will immediately evaluate all current inpatients and decide who can be safety discharged The <Insert position title and/or department(s)> will facilitate patient discharges, notify the <Insert position title and/or department(s)> of all available beds. The <Insert location> will serve as the holding area for discharged patients awaiting transportation from family or friends. Facility admissions and scheduling for elective procedures may be curtailed until the emergency situation has subsided.
All personnel will report to their assigned area. The <Insert position title and/or department(s)> will take stretchers, wheelchairs and blankets to the Triage area. As the victims arrive, assigned nurses will assist physicians in evaluating patients and direct them to the appropriate treatment area with treatment orders. Victims requiring immediate life-saving procedures will be taken directly to the <Insert location (e.g., emergency room)>. The <Insert position title and/or department(s)> will tag the victims as they arrive in the treatment area. See Appendix P: Surge Capacity.
B. Vulnerable Populations
Vulnerable populations are patients who are pediatric, geriatric, disabled, or have serious chronic conditions or addictions. As these patients are identified in the triage process, they will be linked with needed hospital services. For those services the inpatient facility cannot provide, social service personnel will assist the patient by linking them with healthcare or social service agencies that can provide the required assistance.
C. Management of Behavioral Health Patients
The management of patients receiving behavioral health services will be coordinated with the <Insert position title and/or department(s)> and security as necessary. Patient medications and medical records should accompany the patient in a bag around the patient’s neck in the event they are being transferred or evacuated to another facility. Coordination should be made with the receiving facility so it can adequately accommodate the patient.
D. Behavioral Health Services to Patients
Prior to an emergency, the <Insert position title and/or department(s)> will establish links with local community mental health centers and community service organizations to identify community resources that can respond to the mental health needs of patients in an emergency. Current contact information will be maintained for these organizations so patients, their families, and others can be referred to those resources if needed. The
26
<Insert position title and/or department(s)> will also ensure that appropriate facility personnel have been trained in psychological first aid or other psychosocial interventions to ensure the facility can provide support or direction to patients needing such care.
During and after an emergency, the <Insert position title and/or department(s)> will coordinate hospital and community mental health resources to provide support for patients, family members and staff.
E. Patient Tracking
<Insert Facility’s Tracking Policy, if no policy in place describe below>
Inpatient facility departments receiving disaster-related patients will have a patient tracker assigned to track the patients entering and leaving the patient care areas. The <Insert position title and/or department(s)> staff will use the HICS Form 254 - Disaster Victim Patient Tracking Form (See sample HICS forms in Attachment D), using the triage tracking number to log in patients at the point of triage. The location of these patients in the continuum of care will be logged in using this form until disposition status is determined.
In the event that the computer system is down, the registration staff will coordinate the use of the Disaster Victim Patient Tracking Form (HICS Form 254) with the <Insert facility patient tracking system>.
Ensure that all patient identification wristbands (or equivalent identification) must be intact on all patients.
If patients are evacuated, the HICS Form 260 - Patient Evacuation Tracking Form will be used. When more than two patients are being evacuated, the HICS Form 255 - Master Patient Evacuation Tracking Form (See sample HICS forms in Attachment D) should be used to gain a master copy of all those that were evacuated. Form should include, but is not limited to: resident name, date of birth, insurance information, evacuation site location, date of evacuation, arrival time at evacuation site, date of return to facility (if known), and comments/notes.
Each patient unit, in conjunction with the <Insert position title (e.g., Patient Tracking Manager)>, shall designate a team member responsible for this task. The information for each patient must be completed when the receiving facility is contacted and a report given regarding the patient’s status. The <Insert position title (e.g., Patient Tracking Manager)> or designee shall assist the evacuating unit as necessary to assure that appropriate tracking information is completed for each patient care unit.
Applicable inpatient facilities should describe their utilization plan for Louisiana’s “At Risk Registry” or other tracking applications here.
27
10. UTILITIES AND SUPPLIES
A. Power
In the event of an outage, the emergency generator will provide power to the facility. The <Insert position title and/or department(s)> will call the power company to report the outage and get an estimated time that the power will be restored. The <Insert position title and/or department(s)> will notify all departments of the power failure and the status of repair. In the event a power failure happens after normal business hours, the <Insert position title (e.g., Dispatcher) and/or department(s)> will immediately notify the <Insert position title and/or department(s)> to report the outage.
Table 7Generator Details
Generator Details Generator 1 Generator 2 Generator 3
Generator make/model
Watt rating
Type of fuel required
Tank capacity
Number of hours of power can be generated using full fuel supply
What triggers refueling of tanks for generators?
Essential services supported by the generator
Minimum kW needed for essential services
Date of last full load test performed
Type of external hook up needed for generator
Person Responsible for: Primary Backup 1 Backup 2
Obtaining fuel
Fuels generator
Oversees maintenance contract
28
Company/Agency Name Type Fuel Provided
Contact Name Phone
Primary:
Backup 1:
Backup 2:
Generator Failures
In the event of a generator failure, the problem is immediately assessed by the <Insert position title and/or department(s)>, who will make needed repairs or contact the <Insert name and contact information of generator maintenance company>. MSTAT should then be updated with the facility’s operating status.
If the hospital’s power distribution system fails and cannot be repaired in a reasonable time-period, the Regional Hospital DRC should be notified. The Emergency Response Coordinator, < Inset name/titles of key administrative personnel>, and the Regional Hospital DRC will assess if resources are available to provide assistance or if evacuation is necessary.
B. Water
Water for Drinking, Cooking, and Sanitation
If there is an interruption in water service, the problem will be immediately assessed by <Insert position title and/or department(s)>, who will make needed repairs or contact <Insert name and contact information for water supplier> to report the outage and get an estimated time that water service will be restored. The <Insert position title and/or department(s)> will notify all departments of the water service interruption and anticipated time of restoration. If a water service interruption happens after normal business hours, the <Insert position title (e.g., Dispatcher> will immediately notify the <Insert position title and/or department(s)> to report the situation. The <Insert position title> will determine if water use restrictions should be implemented (e.g., bathing, cooking, etc.), or if patient relocations, discharges, or transfers are necessary.
29
Water Usage
Estimate water usage under normal operating conditions to determine water needs during a water restriction situation. <Insert estimated 4 day water usage for facility>. Reference Table 6-4.1 from CDC Emergency Water Supply Planning Guide.
Amount On Hand
Identify quantities of potable and non-potable water on-site and identify vendors for acquiring additional potable and non-potable water.
Table 8Quantities of Potable and Non-Potable Water
Type QuantityPotable Water
Bottled Water (units)
Storage Tank (gallons)
Water Well (gallons)
Other
Non-Potable Water
Fire Department
Other
Acquiring Additional Water
Potable water can be supplied through:
List supplier name/contact information
Non-potable water can be supplied through:
List supplier name/contact information
30
Water Rationing
If an emergency situation is anticipated that could affect water supplies, certain measures can be initiated to ensure the facility has enough potable and non-potable water to supply the facility until water service is restored. The facility can stockpile bottled water for drinking and cooking. If the event allows, containers capable of holding water can be filled prior to the event including pots, buckets, and bath tubs.
If an event occurs that limits water supplies to the facility, water rationing measures may be initiated to conserve water until water supplies have been restored. Patient sanitary needs will be addressed by the use of bedside toilets or bedpans. Waste from bedside toilets or bedpans will be red-bagged and disposed of as bio-hazardous waste. Another method is the use of cat litter in red bags. If using this method, the red bags and cat litter will be placed in toilets. When deemed necessary by Infection Control or when water service is restored, the red bags will be removed from the toilets and disposed of as biohazard waste.
Water used for bathing and cleaning may have to be restricted. Hand washing will require soap and water, if in sufficient quantity. If water is unavailable, the use of hand sanitizers will be encouraged. Fruit juices and broth, which should normally be discarded in preparing meals, could be set aside for use in preparing meals that may call for adding water. <Insert Facility Policy>
Water Decontamination
In the event water needs to boiled or otherwise decontaminated, contact the local Office of Public Health for guidance. The contact for the local Office of Public Health is <Insert contact name and contact information>.
C. Medical Gas/Vacuum Systems
In the event of a loss of the vacuum system, the <Insert position title and/or department(s) and facility administration> must be notified immediately. They will determine if repairs can be made in an expeditious manner or whether portable suction equipment beyond reserve units must be procured. In any event, nursing personnel in affected areas must ensure that patients with artificial airways and those in need of tracheal suction receive priority attention until the patient is relocated to an unaffected area or the primary vacuum system is restored.
In the event of a loss of medical gases, the <Insert position title and/or department(s) and facility administration> must be notified immediately. The
31
responsible individual will determine if repairs can be made in an expeditious manner or if emergency medical gas supplies must be procured.
The facility maintains <Identify the amount of medical gas available and the location>. Additional cylinders can be procured through <Insert name and contact information of supplier>.
32
11. OTHER CRITICAL UTILITIES
Maintenance Activities
The following table lists other utilities critical to the comfort and care of residents and daily operations that should be addressed for maintenance.
Table 10Maintenance Activities
System Primary Personnel
24/7 Contact Information
Outside of Facility
24/7 Contact Information
Generators/ElectricHeating, ventilation, and air conditioningWater/Sewer SystemsMedical Gases/Vacuum SystemsInformation TechnologyList others that apply
33
12. EVACUATION
A. Decision Making: Evacuate or Shelter-in-Place
The decision whether to evacuate the facility or shelter-in-place will rest with the <Insert position title(s)>, who will be responsible for deciding which action to take and when evacuation or shelter-in-place activities should commence. The decision will be made in consultation with facility staff and external stakeholders such as emergency management, fire department, or public health personnel. Both internal and external factors will be considered in deciding whether to evacuate or shelter-in-place.
Internal factors could include the physical structure of the facility, patient acuity, staffing, accessibility to critical supplies, availability of transportation assets for evacuation (not including ambulances), and accessibility of possible evacuation destinations. External factors to be considered in making the decision to evacuate or shelter-in-place include the nature and timing of the event, the location or projected path of the threat such as in the case of a flooding incident, ice storm or hurricane, and the vulnerability of the facility to the threat.
B. Transportation Resources
The <Insert name of facility> will identify appropriate resources to transport the patient population, staff, supplies and necessary equipment in the event evacuation of the facility is necessary. The facility will seek to identify primary and back-up transportation providers with suitable vehicles and personnel to ensure adequate resources are available in an emergency.
The following transportation entities have agreed to provide transportation to the <Insert name of facility – see Table 12> in the event evacuation of all or part of the facility is necessary. If these entities are not able to provide transportation resources, the facility will request resources through the <Insert name of local Office of Homeland Security and Emergency Preparedness>.
Table 12Transportation Resources
Name of Agency/Company
Types of Transportation
Equipment AvailableContact Name
Contact Number
Alternate Contact
Information
34
C. Patient Records and Maintenance
In the event of an evacuation, patient records should be moved with the patient to the receiving facility.
Describe the procedure for ensuring patient records are transported with the patient and identify who is responsible.
The <Insert position title> is responsible for maintaining and transferring patient records during an event. Facility patient records may be stored digitally on a computer’s hard drive, on CDs, and/or maintained in hard copy files. Computers will be unplugged, moved to a higher location in the building, or moved offsite. Digital records will be saved to a removable storage medium (e.g., CD, DVD, USB flash drive, thumb drive) and carried offsite. Assessing the backup of the electronic data retrieval system will be a function of the annual review of the emergency preparedness system.
Hard copies of records will be stored in such a way that the critical records can be gathered and transported. The <Insert name of facility> has implemented/ is considering scanning critical data/documents. Critical data includes:
Patient information (e.g., face sheets, clinical data, physician orders, care plans)o Nameo Social Security Numbero Photographo Medicaid or other health insurance numbero Date of Birtho Diagnosiso Current drug/prescriptions and dietary regimenso Name and contact of next of kin/responsible person/Power of Attorney
Family information (e.g., contact information) Reference Health Insurance Portability and Accountability Act Policy
D. Patient Provisions/Personal Effects
In an evacuation, provisions for patient care will also be moved with the patient to ensure adequate medical care is maintained throughout the evacuation and care at the receiving facility. This will include necessary medications, medical equipment, supplies, staff, and psychological first aid to care for patients. Procedures are in place to ensure patient’s personal effects are also transferred with the patient.
Describe procedures for ensuring provisions for patient care, including food, one gallon/person of water, and medications, and transport of personal effects are addressed in an evacuation and identify the staff and/or responsible departments.
E. Evacuation Locations
35
If the facility is damaged to the extent that patient care cannot be rendered, or it is determined that evacuation is warranted due to fire, an approaching hurricane, or other hazard, patients may be transported to a receiving facility for temporary care. The terms “close”, “within area”, and “outside of area” represent the concept that healthcare facility patients need to move as short a distance as possible. The farther frail patients must travel, the less safe the evacuation becomes for them. Therefore, the distance traveled must be balanced with the possible harm extended travel may cause.
Close Proximity
Close proximity locations are within a short distance (within 10 miles) from the facility and will be utilized when unplanned or immediate evacuations are necessary.
Table 13Close Proximity Evacuation Locations
Location Facility Name Address Phone Number Alternate Contact
Primary
Backup 1
Backup 2
Within Area
Within area locations are those within a reasonable distance (within 10 - 50 miles) from the facility and will be utilized for unplanned or planned evacuations relative to the type of hazard or threat to the facility.
Table 14Within Area Evacuation Locations
Location Facility Name Address Phone Number Alternate Contact
Primary
Backup 1
Backup 2
36
Out of Area
Out of area locations are a significant distance (over fifty miles) from the facility and will be utilized for planned evacuations.
Table 15Out of Area Evacuation Locations
Location Facility Name Address Phone Number Alternate Contact
Primary
Backup 1
Backup 2
F. Evacuation Routes
Floor plans with evacuation routes and maps to evacuation locations are located in Attachment C: Alternate Care Sites Evacuation Routes and Facility Floor Plans.
G. Evacuation Priorities
<Insert description of order of patient evacuation>
H. Securing Equipment
The <Insert position title> will be responsible for ensuring facility equipment is secure or is safely moved in the event of an evacuation of the facility. The facility should be mindful that some medical and diagnostic equipment must be re-calibrated after being moved or disconnected from a power source. Mutual aid agreements with other healthcare facilities should be sought and maintained for the sharing of equipment and/or resources in an emergency.
37
Include mutual aid agreements located in Attachment B.
I. Securing Vital Records
The <Insert position title> will be responsible for ensuring vital departmental records are secure or are safely moved in the event of an evacuation of the facility. The <Insert position title> will be responsible for coordinating with the <Insert name of departments (e.g., medical records, information technology, accounting, human resources)> to ensure proper procedures are followed in moving and/or securing these records.
38
13. RECOVERY
A. Initiation and Recovery
The decision to enter into the recovery stage of an event is made by the <Insert position title>. In this stage, the <Insert name of facility> will undertake recovery procedures to return the facility to normal operations.
B. Protocol
In order to efficiently recover from an event, protocols must be followed. Listed below are protocols important to recovery operations.
Recovery protocols:
Prioritize health care service, delivery, and recovery objectives by organizational essential functions.
Maintain, modify, and demobilize healthcare workforce according to the needs of the facility.
Work with local emergency management, service providers, and contractors to ensure priority restoration and reconstruction of critical building systems.
Maintain and replenish pre-incident levels of medical and non-medical supplies.
Work with local, regional, and state emergency medical system providers, patient transportation providers, and non-medical transportation providers to restore pre-incident transportation capability and capacity.
Work with local emergency management, service providers, and contractors to restore information technology and communication systems.
Prepare after-action reports, corrective action reports, and improvement plans.
C. Restoration of Services
The <Insert position title> will coordinate the restoration of services after an emergency situation affecting the hospital.
List responsibilities in restoring services (e.g., restoration of utilities, repair or replacement of critical systems, and overseeing of facility repairs).
39
D. Utility Restoration
Describe procedures for restoration of critical systems not already identified in the plan or identify where these procedures can be located.
E. Staff/Patient Re-Entry
The <Insert position title> will work with the Louisiana Department of Health to give approval for the return of staff and patients to the facility. The coordination of the return of staff and patients to the facility will be the responsibility of the <Insert position title>.
List preparations and procedures for returning residents after an emergency (e.g., transport of patients back to the facility and related activities).
F. Staff Debriefing
A debriefing will be conducted within <Insert number of hours> of the incident to collect lessons learned from the incident or exercise. These lessons learned will be used to revise and update the plan. The <Insert position title> will be responsible for coordinating the debriefing.
G. After-Action Report/Improvement Plan
After any real incident or exercise where the emergency operations plan is activated, an after-action report and an improvement plan will be developed. The purpose of the after-action report is to document the overall performance of the organization during the exercise or real event. It will contain a summary of the scenario or events, staff actions, strengths, issues, opportunities for improvement, and best practices.
The purpose of the after-action report/improvement plan is to ensure issues and opportunities for improvement are adequately addressed to improve response capabilities to future events. The improvement plan will include a list of issues to be addressed, tasks that will be performed to address them, individuals responsible for completing the tasks, and a timeline for completion.
The <Insert position title> will be responsible for coordinating the development of the after-action report and improvement plan and will ensure identified improvements are completed within the targeted timeframes.
40
14. GLOSSARY
Activation - When all or a portion of the plan has been put into motion.
After-Action Report (AAR) - A report that includes observations of an exercise or real event and that makes recommendations for improvements. The purpose of the after-action report is to document the overall performance of the organization during the exercise or real event. It will contain a summary of the scenario or events, staff actions, strengths, issues, opportunities for improvement, and best practices.
At-Risk-Registry – evacuation web-based system that allows real-time tracking of patients during a facility evacuation.
Communications Redundancy - A communications system wherein alternative modes of communication are present in case a component fails.
Continuity of Operations (COOP) Plan (Business Continuity) - Planning designed to facilitate the continuance of mission essential functions and the protection of vital information in the event that the organization is faced with a situation that could disrupt operations.
Corrective Action Plan (CAP) - The concrete, actionable steps outlined in the Improvement Plan (IP) that are intended to resolve preparedness gaps and shortcomings experienced in exercises or real-world events.
Decontamination - The process of making safe by eliminating poisonous or otherwise harmful substances, such as noxious chemicals or radioactive material.
Delegations of Authority - Specifies who is authorized to make decisions or act on behalf of facility leadership and personnel if they are away or unavailable during an emergency.
Devolution Site - Alternate site designated for Continuity of Operations if original site is compromised.
Emergency Operations Center (EOC) - A specially equipped facility from which emergency leaders exercise direction and control, and coordinate necessary resources in an emergency situation.
ESF8 Portal – The gateway to a suite of applications used to gather Emergency Status information on facilities licensed by the Louisiana Department of Health.
Hazard Vulnerability Analysis (HVA) - Identifies possible hazards, including their probability, severity, frequency, magnitude, and locations/areas affected.
41
Health Alert Network (HAN) - A nationwide program to establish the communications, information, distance-learning, and organizational infrastructure used to defend against health threats, including the possibility of bioterrorism.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) - U.S. government legislation that ensures a person’s right to buy health insurance after losing a job, establishes standards for electronic medical records, and protects the privacy of a patient’s health information.
Homeland Security Exercise and Evaluation Program (HSEEP) - Developed by the Department of Homeland Security (DHS) as a threat and performance-based exercise program that provides doctrine and policy for planning, conducting, and evaluating exercises. HSEEP was developed to enhance and assess terrorism prevention, response, and recovery capabilities at the federal, state, and local levels. HSEEP training courses are free and available online.
Human-Caused Events - An event that is a result of human intent, negligence, or error, or involving a failure of a man-made system. Includes terrorism, criminal events, biological events, hazardous material and chemical spills, extended power outages, fires, or any event for which a human is responsible.
Improvement Plan (IP) - Identifies specific corrective actions, assigns to responsible parties, and establishes targets for completion.
Incident Command System (ICS) - A standardized, on-scene, all-hazards incident management approach that allows for the integration of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure; enables a coordinated response among various jurisdictions and functional agencies, both public and private; and establishes common processes for planning and managing resources.
Isolation - The separation of an ill patient from others to prevent the spread of an infection or to protect the patient from irritating or infectious environmental factors.
Key Personnel - Personnel designated by their department, organization, or agency as critical to the resumption of mission-essential functions and services.
Long Term Care Facility - A facility that provides rehabilitative, restorative, and/or ongoing skilled nursing care to patients and residents in need of assistance with activities of daily living. Long term care facilities include nursing homes, rehabilitation facilities, inpatient behavioral health facilities, and long-term chronic care hospitals.
Mission Essential Functions (Essential Functions) - Activities, processes, or functions that could not be interrupted or unavailable for several days without significantly jeopardizing the operation of the department, organization, or agency.
42
Mitigation - The stage of emergency management where activities are conducted that eliminate or reduce the possibility of a disaster occurring. For healthcare operations, this might include the installation of generators for backup power, the installation of hurricane shutters, or the raising of electrical panels to protect from possible flood damage.
MSTAT- an application housed on the ESF8 Portal used by facilities to report current operating status, power status, fuel status, census, and bed availability information. In addition, nursing homes use MSTAT to track patient information during facility evacuations.
Mutual Aid Agreements (MAA) - Arrangements made between governments or organizations, either public or private, for reciprocal aid and assistance during emergency situations where the resources of a single jurisdiction or organization are insufficient or inappropriate for the tasks that must be performed to control the situation. These are also referred to as inter-local agreements or Memorandum of Understanding (MOU).
National Incident Management System (NIMS) - A systematic, proactive approach to guide departments and agencies at all levels of government, nongovernmental organizations, and the private sector to work seamlessly to prevent, protect against, respond to, recover from, and mitigate the effects of incidents, regardless of cause, size, location, or complexity, in order to reduce the loss of life and property and harm to the environment.
Natural Disasters - The effect of a natural hazard that affects the environment and leads to financial, environmental, and/or human losses. Includes severe weather events such as hurricanes, tropical storms, thunderstorms, snow and ice storms, mudslides, floods, and wildfire events.
Orders of Succession - Ensures leadership is maintained throughout the facility during an event when key personnel are unavailable.
Personal Protective Equipment (PPE) - Specialized clothing or equipment worn by an employee for protection against infectious materials.
Preparedness - The stage of emergency management where activities are conducted to develop the response capabilities needed in the event an emergency occurs. These activities may include developing emergency operations plans and procedures, conducting training for personnel in those procedures, and conducting exercises with staff to ensure they are capable of implementing response procedures when necessary.
Public Health - The science and practice of protecting and improving the health of a community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.
43
Public Information - Information that is disseminated to the public via the news media before, during, and/or after an emergency or disaster.
Recovery - The stage of emergency management that focuses on restoring operations to a normal or improved state of affairs. This stage occurs after the stabilization and recovery of essential functions. Examples of recovery activities might include the restoration of non-vital functions, replacement of damaged equipment, and facility repairs.
Response - The stage of emergency management that includes those actions that are taken when a disruption or emergency occurs. It encompasses the activities that address the short-term, direct effects of an incident. Response activities in the healthcare setting can include activating emergency plans, triaging, and treating patients that have been affected by an incident.
Standard Operating Guidelines (SOG) - A set of approved methods for accomplishing a task or set of tasks. SOGs are typically prepared at the department or agency level. They may also be referred to as Standard Operating Procedures (SOPs).
Vital Records, Files and Databases - Records, files, documents, or databases, which if damaged or destroyed, would cause considerable inconvenience and/or require replacement or re-creation at considerable expense. For legal, regulatory, or operational reasons, these records cannot be irretrievably lost or damaged without materially impairing the organization's ability to conduct business.
Vulnerable Populations - Vulnerable populations are patients who are pediatric, geriatric, disabled, or have serious chronic conditions or addictions.
44
15. ACRONYMS
AAR After-Action ReportAHRQ Agency for Healthcare Research and QualityCAP Corrective Action PlanCD Compact DiscCDC Centers for Disease Control and PreventionCMS Centers for Medicare and Medicaid ServicesCOOP Continuity of Operations PlanDRC Designated Regional Coordinator (Hospital and EMS) DHS Department of Homeland SecurityEMC Emergency Management CoordinatorEMS Emergency Medical ServicesEOC Emergency Operations CenterEOP Emergency Operations PlanEP Emergency PlannerEPA Environmental Protection AgencyEPN Emergency Preparedness NurseERC Emergency Response CoordinatorESAR-VHP Emergency System for Advance Registration of Volunteer Health
ProfessionalsESF Emergency Support FunctionFBI Federal Bureau of InvestigationFDA Food and Drug AdministrationFEMA Federal Emergency Management AgencyGOHSEP Governor’s Office of Homeland Security and Emergency PreparednessHAN Health Alert NetworkHC HealthcareHCF Healthcare FacilityHICS Hospital Incident Command SystemHIPAA Health Insurance Portability and Accountability ActHPP/WMD Hospital Preparedness Program/Weapons of Mass DestructionHSEEP Homeland Security Exercise and Evaluation ProgramHVA Hazard and Vulnerability AnalysisHVAC Heating, Ventilation and Air ConditioningIC Incident CommandICS Incident Command SystemIP Improvement PlanIS Independent StudyJAS Job Action SheetsJIC Joint Information CenterJIS Joint Information SystemMAA Mutual Aid AgreementMERCs Mortuary Enhanced Remains Cooling SystemMOU Memorandum of UnderstandingMUL Mortuary Unit Leader
45
NFPA National Fire Protection AssociationNIMS National Incident Management SystemNOAA National Oceanic and Atmospheric AdministrationNWS National Weather ServiceOHSEP Office of Homeland Security and Emergency PreparednessPIO Public Information OfficerPOC Point of ContactPOD Point of DistributionPHERC Public Health Emergency Response Coordinator PPE Personal Protective EquipmentSOG Standard Operating GuidelinesSOP Standard Operating Procedures
46
16. ATTACHMENTS
Attachment A: Training Plan
Attachment B: Mutual Aid Agreements/Memorandum of Understanding in Place
Attachment C: Sample Hospital Incident Command System Forms
Attachment D: Affiliated Facilities Specific Information
47
Page Intentionally Left Blank
48
A. Training Plan
<Insert Facility Staff Training Requirements> and include the following:
It is recommended all employees receive specific training during new employee orientation and at least annually on:
Facility Emergency Preparedness Policies and Procedures IS-100.HC, IS-200.HC, IS-700, IS-800, IS-300 and 400 for applicable personnel: (Other as indicated by the facility)
The facility should be able to provide documentation of completion of all trainings.
NIMS for Louisiana Hospitals - http://www.lha-foundation.org/getattachment/Emergency_Preparedness/All-Hazards-Planning/NIMS.pdf.aspx
National Incident Management System (NIMS) - Federal Emergency Management Agency (FEMA) http://www.training.fema.gov/is/
National Incident Management System (NIMS) - (FEMA) Implementation for Healthcare Organizations Guidance http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/nims-implementation-guide-jan2015.pdf
49
http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/nims-implementation-guide-jan2015.pdf
B. Exercises
The <Insert name of facility> will test its plan and operational readiness at least annually. This will be done by participating in full-scale community exercises and/or facility-based exercises and table-top exercises.
An After-Action Report/Improvement Plan will be completed in a timely manner This improvement plan will be incorporated into the plan as soon as it is feasible. The <Insert position title> will be responsible for coordinating the exercises, AARs, and improvement planning.
All exercises should incorporate principles of the National Incident Management System (NIMS), Hospital Incident Command System (HICS). The Homeland Security Exercise and Evaluation Program (HSEEP) is a resources for exercise design and implementation. Information on the Homeland Security Exercise and Evaluation Program can be found at https://www.preptoolkit.org/web/hseep-resources.
Future exercises should be planned and conducted according to improvement action items identified during previous exercises.
Table 2Exercises Conducted
Type of Exercise Hazard Exercised Date of Exercise AAR Completed
50
C. Mutual Aid Agreements/Memorandum of Understanding
List existing Mutual Aid Agreements (MAA) and/or Memorandum of Understanding (MOU). MAAs/MOUs are stored <Insert Location>.
Table 16Mutual Aid Agreements/Memorandum Of Understanding
Facilities/Agencies in Agreement
Nature of Agreement
Expiration Date (if applicable) Date Verified/POC
Sysco* Emergency Food Supply
None
XYZ Hospital* Shelter
Transportation service*
Transport
Additional MOUs
*Examples
51
D. Sample Hospital Incident Command System Forms
Hospital Incident Command System (HICS) forms are found at http://www.emsa.ca.gov/hospital_incident_command_system_forms_2014
HICS 203 – Organization Assignment List
HICS 207 – Hospital Incident Management Team Chart
HICS 254 – Disaster Victim / Patient Tracking
HICS 255 – Master Patient Evacuation Tracking
HICS 257 – Resource Accounting Record
HICS 260 – Patient Evacuation Tracking Form
52
E: Affiliated Facilities Specific Information (if applicable)
This attachment should include the following location specific information:
Table 2: Exercises Conducted Table 3: Individuals Responsible for Emergency Operations Plan Activation Table 4: Roles and Responsibilities Table 6: Delegations of Authority List of Top Five Hazards from Facility Hazard Vulnerability Analysis Facility Floor Plan Table 17: External Contacts Attachment 2: Table 1: Employee Emergency Call Back Roster Attachment 2: Table 6: Critical Infrastructure Contact Information Facility Hazard Vulnerability Analysis (HVA) Community Hazard Vulnerability Analysis – reference local Parish OHSEP.
53
17. ANNEXES
Annex A: Communications
Annex B: Safety and Security
Annex C: Continuity of Operations
Annex D: Hazard Vulnerability Analysis (HVA)
Annex E: Louisiana Volunteers in Action (LAVA)
Annex F: Response Plans (for Identified Priority Threats/Hazards found in HVA)
54
Page Intentionally Left Blank
55
Annex A: Communications
<Reference/Insert Communications Policy>
Internal Communication
To ensure personnel are adequately informed throughout the course of emergency response activities, the facility will provide updates and general information to staff through regularly scheduled briefings, facility internal website, e-mail, etc. This flow of information regarding the incident will continue throughout the emergency until the all-clear signal is given.
Communication with External Response Partners
The Facility’s Liaison will provide updates to external organizations within <Indicate time interval>. To communicate with external agencies, the facility will use <Insert external communication system (e.g., phone tree, radio, media)>.
Table 17External Contacts
Agency Purpose for Contact
Contact Name/Title Phone Alternate
Contact InfoFire
EMS
Parish OHSEP
Police Department
Sheriff
Coroner
DRC (Hospital, EMS, other)
Other Healthcare facilities with MOU’s
Sister Facilities
Ombudsman
56
Attachment 1: Louisiana ESF8 Network Map and Contacts
57
Public Information
The <Insert position title (e.g., Public Information Officer)> will have the responsibility for coordinating media and public information. All media inquiries should be directed to the <Insert position title (e.g., Public Information Officer)>. No other staff member should interact directly with the media unless they have approval from the <Insert position title (e.g., Public Information Officer)>. It is recommended that staff who may serve in this capacity have Public Information Officer training.
Coordination of Public Information with Response Partners
If several agencies are involved in response, the <Insert position title (e.g., Public Information Officer)> will coordinate with them to form a Joint Information Center (JIC). The information that will go out to the community will come from the JIC as a single, consistent, and unified message from all of the affected agencies.
Communication with Patients and Families
Policies and protocols have been established for communication activities prior to and during an emergency. The <Insert position title> will communicate updates every <Insert time interval> in the <Insert location>.
Planning Activities
Facility’s plan should include the following communication planning activities the facility is or will be conducting: safety information upon admission of the patient, collaboration with other healthcare facilities and/or community service organizations for patient tracking, and psychological first aid, etc. To ensure communication with patients and their families is consistent and timely during an emergency, this facility has established and will continue to develop family contact lists for patients and working relationships with local, state, and federal partners to ensure patients' safety, physical, and psychological needs are met during a disaster. Facility should ensure that families are aware of and knowledgeable about the facility plan, including: how and when they will be notified about evacuation plans, how they can be helpful in an emergency (e.g., coming to the facility to assist), and how/where they can plan to meet their loved ones. Out-of-town family members should be given a number they can call for information. Residents who are able to participate in their own evacuation should be informed and aware of their roles and responsibilities in the event of a disaster.
58
Response Activities
<Insert Facility’s plan for establishing a family support center>
This facility has pre-designated points for families to meet during an emergency where they will be given updates during the event on the patients and how the incident is being mitigated. At the time of the incident, families will be directed to this location upon arrival at the facility. These locations are subject to change due to the unknown nature of the incident.
Communication with Vendors of Essential Supplies, Services and Equipment
The <Insert name of facility> has developed a list of vendors, contractors, and consultants that can provide specific services before, during, and after an emergency event. The <Insert position title> is responsible for maintaining the list. This list will be updated periodically but no less than annually. The list includes the name of the vendor and the supplies, services, or equipment provided to the hospital, a phone number, and alternate contact information.
Communication with Other Healthcare Organizations
The Facility Liaison (or name other role) will be responsible for providing key information to other healthcare organizations. Key information to be shared with other healthcare organizations in the community during a disaster includes:
Command structures, including names and contact information for the command center
Essential elements of the facility’s command center
Resources and assets that can be shared
Process for the dissemination of the names of patients and the deceased for tracking purposes
59
Communication about Patients to Third Parties
<Reference Hospital HIPAA Plan/Policy>
Backup Communications Redundancy and Equipment
List backup communications equipment and systems to be used in the event of telephone failure (must include communication plan e.g., radios, runners).
Table 18Communication Methods
Internal/External Primary Alternate TestingInternal* PBX* Runner*Internal* Phone* Vocera*External* Telephone* Satellite Radio, Ham Radio*
*Examples
Use of Plain Text by Staff in Emergencies
To launch an effective response to an emergency event, it is critical that communications between responding agencies and personnel are clear and understandable. To ensure communication is understood in an emergency, staff will use plain text and avoid the use of acronyms, radio ten codes, and other terminology that may lead to confusion in the midst of emergency response activities.
Table 19Internal Facility Emergency Intercom Codes
Code Emergency/Threat
60
Attachment 2: Emergency Call Lists
Table 1: Employee Emergency Call Back Roster
Table 2: Patient Physicians Emergency Call Back Roster
Table 3: Volunteers Emergency Call Back Roster
Table 4: Contractors Emergency Call Back Roster
Table 5: Vendor Contact Information
Table 6: Critical Infrastructure Contact Information
61
Attachment 2: Table 1Employee Emergency Call Back Roster
<Insert Date> (Indicate Location)
Name Department Phone E-mail Address Emergency Staffing Role
62
Attachment 2: Table 2Patient Physicians Emergency Call Back Roster
<Insert Date> (Indicate Location)
Name Department Phone Alternate Phone E-mail Address
63
Attachment 2: Table 3Volunteers Emergency Call Back Roster
<Insert Date> (Indicate Location)
Name Department Phone E-mail Address Emergency Staffing Role
64
Attachment 2: Table 4Contractors Emergency Call Back Roster
<Insert Date> (Indicate Location)
Company Name
Contact Name Phone Alternate
Phone E-mail Address
65
Attachment 2: Table 5Vendor Contact Information
<Insert Date> (Indicate Location)
Vendor Contact Phone Supply/Resource
66
Attachment 2: Table 6Critical Infrastructure Contact Information
<Insert Date> (Indicate Location)
Supply/Resource Vendor Contact Phone E-mail Address
Electricity
Employee Assistance Program
Gas
Internet
Mental Health
Telephone
Transportation
VOIP Vendor
Water
67
Annex B: Safety and Security
Internal Security Measures
<Insert Lockdown Plan/Policy including Mutual Aid Agreements/Memoranda of Understanding with external agencies>
Entrances and Exits (North, East, etc.) Reception
Table 20Internal Security Assignments
Area to Secure Assigned Staff Department Contact Information
Controlling Access
The <Insert position title> will be tasked with maintaining external security along with restricted movement of persons in and out of the hospital parking lot and entryways. Security will be coordinated with security officers and/or staff members from <Insert name of department(s) or available staff from the labor pool>.
Only families of disaster victims, families picking up discharged patients, physicians and individuals assisting in the treatment of victims will be allowed to enter facility property. Employees will park in their regular parking spaces and must present facility ID at designated entrances. Physicians will enter through <Insert location of designated entry area(s)> and will be given identifying badges. All others seeking entrance to the facility shall be directed to <Insert location of designated entry area(s)> for directions or other information. Staff from <Insert name of applicable departments and/or labor pool> may be used to escort families to appropriate areas as needed.
Controlling Movement within the Facility
Movement of people will be restricted based on consultation with the facility Command Center and the exact nature of the emergency. Those individuals with ID badges and temporary identification (volunteers, etc.) will be allowed access throughout the facility
68
to perform their duties. Any visitors, patients, and family members will be restricted to their units unless treatment is required. If this is the case, a hospital staff member will escort the patient to their destination. The Incident Commander, in conjunction with the Operations Section Chief and Security Branch Manager, can alter the flow of non-staff traffic as deemed necessary throughout the event.
Controlling Vehicle Traffic
The <Insert position title> will assign staff members to control traffic at all unsecured entrances. No one without specific facility business is to be permitted beyond that point unless requested by someone with such authority. All visitors, families, etc., will be directed to the appropriate area.
The <Insert position title> will ensure that a security officer or staff person controls the following areas: <Insert external areas, entrances and exits that will require security personnel>. The <Insert position title> will monitor traffic patterns and close off any areas deemed necessary in consultation with the Security Branch Director and the facility Command Center.
Coordination with Local Law Enforcement Agencies
In the event of an internal or external incident the <Insert name of local law enforcement agency> can be called to assist. They will assist with security of the perimeter and manage traffic flow in the event of patient relocation. Any request for additional resources must be coordinated through the <Insert name of local Parish OHSEP>.
69
Annex C: Continuity of Operations
Purpose
Whether due to natural forces such as a hurricane, a technological event such as an electrical fire, or an event caused by humans such as an act of terrorism, a disaster can have a serious impact on the organization’s ability to provide the healthcare functions that patients and the community depend on. Therefore, it is vitally important to have plans in place to be able to continue to perform mission-essential functions and protect vital information in the event that the organization is faced with a situation that could disrupt operations. Continuity of Operations (COOP) planning addresses three possible types of disruption to an organization:
Denial of access to a facility (e.g., damage to a building) Denial of service due to a reduced workforce (e.g., pandemic influenza) Denial of service due to equipment or systems failure (e.g., information
technology systems failure)
COOP planning seeks to minimize the potential impact of these events on employees, operations, and facilities.
Phases of Continuity of Operations Planning
There are three phases to the COOP process:
Normal Operations (mitigation and preparedness) COOP Execution (emergency operations period) Reconstitution (return to normal operations)
Normal Operations
Normal operations are those periods without a declared state of emergency or the period directly following the conclusion of an event. Mitigation and planning activities can be conducted during normal operations to protect systems and prepare for an emergency affecting information systems.
Mitigation activities are those that eliminate or reduce the possibility of a disaster occurring. For IT systems, this would include measures to protect equipment and critical information such as backup power, firewalls, virus protection, password protection of files, and data redundancy.
70
Preparedness activities develop the response capabilities that are needed in the event that an emergency occurs. These activities may include developing response procedures for the backup and restoration of data, training personnel in those procedures, conducting system(s) tests, executing regular backups of data, developing manual interim process to ensure continuous service of essential functions, and conducting exercises with staff to ensure they are capable of implementing response procedures when necessary.
COOP Execution
The COOP execution phase includes the actions that are taken when an emergency occurs. This includes activating emergency procedures and staff to protect or restore information systems and data for essential functions of the <Insert name of facility>.
Reconstitution
Recovery focuses on restoring the essential functions to a normal or improved state of affairs. It occurs after the stabilization and recovery of essential functions. Examples of recovery activities might include the restoration of non-vital functions, replacement of damaged equipment and facility repairs.
Continuity Elements
During an emergency, continuing operation of essential functions is imperative. In order to more efficiently continue operation of essential functions, the following continuity elements have been listed:
Orders of Succession: Located in Command and Coordination Section. Delegations of Authority: Located in Command and Coordination Section. Risk Assessments and Hazard Vulnerability Analysis: Located in Attachment 1
and 2 of this Annex.
Continuity Facilities
The <Insert name of facility> has identified continuity facilities to conduct business and/or provide clinical care to maintain essential functions when the original property, host facility, or contracted arrangement where the facility conducts operations is unavailable for the duration of the continuity event. The table below lists the pre-arranged alternate sites, devolution sites, and telework options.
71
Table 21Continuity Facilities
Continuity Facility
Type of Facility Location of Facility
Accommodations
ABC Hospital* Alternate/Devolution Site
1234 Medical Center Drive, Niceville, MS
Identified meeting rooms with telephones, internet access, ham radio access, satellite radio access, 2 desktop computers, laptop connectivity
Parish EOC* Alternate/Devolution Site
7000 Disaster Way, My Town, Gotham City
Possible meeting room with telephones, internet access, shared ham radio capability, shared satellite phone capability, no desktop computers, laptop connectivity
Home Telework*
Alternate/Devolution Site
Home of Record Facility Leadership
Telephones, internet access, no ham radio, no satellite phone, desktop computers, laptop connectivity
*Examples (Insert appropriate details)
Table 22Alternative Care/Surge Site Locations
Facility Name Admin Facility
Emergency Care
Acute Care beds
available
Low Acuity Skilled Nursing
CareHCC Headquarters*
St. Joseph’s Training Room
N/A N/A N/A N/A
Hospital A* Contracted Hot site
Deployable Shelter
Sister Facility
Reopen Closed Wards
Affiliated LTC
Hospital B* No Admin Location
Mobile Trailer
No Acute Care Capability
College Gymnasium
No Long Term Capability
Nursing Home*
Affiliated System
Affiliated System
Affiliated System
Affiliated System
Affiliated System
Dialysis Center*
No Admin Location
Closest ER Closest Hospital
Closest Hospital
Closest LTC
*Examples (Insert appropriate details)
72
Continuity Communications
The <Insert name of facility> maintains a robust and effective communications system to provide connectivity to internal response players, key leadership, and state and federal response and recovery partners. The facility has established communication requirements that address the following factors:
Facilities possess, operate and maintain, or have dedicated access to communication capabilities at their primary facilities, off-sites and pre-identified alternate care/devolution sites
Facility leadership and members possess mobile, in-transit communications capabilities to ensure continuation of incident specific communications between leadership and partner emergency response points of contact
Facilities have signed agreements with other pre-identified alternate care sites to ensure adequate access to communication resources
Facilities possess interoperable redundant communications that are maintained and operational as soon as possible following a continuity activation, and are readily available for a period of sustained usage for up to 30 days following the event
Table 23Interoperable Communications Capabilities
Healthcare Facility
Primary Contact
Secondary Contact
700/800 MHZ
Satellite Phone
Ham Radio
Hospital A* Bob Smith 1-800-000-777Email:
Jane Johnson 1-555-222-0005
Yes MSWIN Channel 6
8816-763-27031
Joe Thatcher General Class
*Example (insert appropriate details)
73
Essential Records Management
The <Insert name of facility > keeps all essential hardcopy records in a mobile container that can be relocated to alternate sites. In addition, electronic records, plans, and contact lists are maintained by the organization’s leadership and can be accessed online and retrieved on system hard drives when applicable and appropriate. Access to and use of these records and systems enables the performance of essential functions and reconstitution to normal operations.
Delegation of Authority
The <Insert name of facility > devolution option requires the transition of roles and responsibilities for performance of facility essential functions through pre-authorized delegations of authority and responsibility. The authorities are delegated from facility leadership to other representatives in order to sustain essential functions for an extended period. The devolution option will be triggered when one or more facility leaders are unable to perform the required duties of the position. The responsibilities of the position will be immediately transferred to designated personnel in the delegation of authority matrix. Personnel delegated to conduct facility activities will do so until termination of devolution option.
Mission Essential Functions
The <Insert name of facility> has established the following list as sample essential functions during a continuity of operations activation. The sample essential functions identified are:
Emergency Services Surgical Services Laboratory Services Health Information Technology Patient Care Unit Central Supply Human Resources Obstetrics Pharmacy Services Public Relations Food Services Security Laundry Health Information Management Infusion Chemotherapy
74
Roles and Responsibilities for Information Technology Continuity of Operations
The positions responsible for overseeing Information Technology Continuity of Operations are: (fill in the blanks)
75
Plans and Procedures for Information Technology Continuity of Operations
Describe the organization’s plan/procedures for backing up vital data:
76
Name
Contact
Alternate Contact Roles and ResponsibilitiesBackup 1
Name
Contact
Alternate ContactRoles and ResponsibilitiesLimitations
Backup 2
Name
Contact
Alternate ContactRoles and ResponsibilitiesLimitations
Backup 3
Name
Contact
Alternate ContactRoles and ResponsibilitiesLimitations
Describe how personnel are trained on the plans/procedures for backing up vital data:
Does the organization have an emergency service plan? If so, explain:
Describe how the organization plans to minimize service interruptions as a result of necessary scheduled downtime:
Describe the contingency plans that are in place for managing unscheduled operational interruptions:
Describe how end-users are trained in executing downtime plans/procedures:
Describe how data will be retrieved (whether stored on external hardware, the operating system, or as backed up data) in the event of an operational interruption:
Describe the process by which data will be entered into the system as soon as it is restored following an outage or disruption:
Critical Information Technology, Systems, Equipment, and Databases
The chart below identifies critical information technology (IT) systems, equipment and databases that are used by the organization and describes what function the system serves, where it is located, who manages the IT needs of the system, equipment or database, and what those responsibilities are. (Fill in the blanks as appropriate)
77
IT FunctionsName of Critical
System/Equipment/Database
Location Managed By Responsibilities
Communications Systems
Food/Dining Services
Heating, Ventilation, and Air Conditioning
Inventory Management
Other
Patient Management
Security Systems
ANNEX D. Hazard Vulnerability Analysis (HVA)
Attachment 1: Facility Hazard Vulnerability Analysis (HVA)
78
<Insert facility hazard vulnerability analysis here>
79
Attachment 2: Community Hazard Vulnerability Analysis (HVA)
<Insert Community Hazard Vulnerability Analysis provided by Parish OHSEP or other here>
80
Example Hazard/Threat Response Plan (Complete and insert a plan for each of the top 5 priority threats/hazards identified in the facility HVA – reference the incident-specific planning appendices at the end of this document)
POLICY:
To provide guidelines to be followed by <insert facility name> personnel in the event of a <insert hazard/threat identified in the facility’s HVA – example “Tornado” > incident occurring at <insert facility name>.
PROCEDURE:
A. Responsibility for (insert hazard/threat – example “Tornado”) Plan Activation:
1. Describe how notification will occur.
2. List the facility position(s) responsible for implementing this plan.
B. Staff Responsibilities:
1. The first employee(s) to identify the incident should:
a. Describe who will be notified. Describe how notification will occur.
b. Describe how personnel will be notified.
c. Describe immediate actions.
2. Facility staff response.
a. Facility personnel will respond by describing actions by department or leadership role.
b. Describe the facility response.
c. Describe how patients will be managed.
81
Annex E.: Louisiana Volunteers in Action (LAVA)
Purpose
The purpose of this annex is to familiarize healthcare staff and administrators with Louisiana Volunteers in Action (LAVA) and encourage participation and support of the program.
Background
LAVA is administered by the Louisiana Department of Health, Office of Public Health. LAVA works to recruit, credential, train, manage and deploy volunteers (medical and non-medical) to assist during emergencies and day to day activities by providing additional staff to meet health/medical surge needs.
LAVA Operations
Health professionals and others interested in participating in the program should visit the LAVA website at https://www.lava.dhh.louisiana.gov/ .
On the website, volunteers can register for the program, list contact information, professional licensure information, and indicate where and how they would like to volunteer in the event of a disaster. Licensure information is verified through the appropriate state licensing boards. The information supplied to the website by volunteers is confidential and will only be made available to government emergency planners if a disaster is declared. In addition, signing up for the program does not in any way obligate members to respond during a particular crisis.
In the event of a disaster or mass casualty event, potential volunteers will be provided with information regarding volunteer opportunities and given the option to accept or decline. Volunteers are expected to maintain current contact information on the LAVA website
82
18. Incident Specific Appendices (use these for guidance in developing response plans to priority hazards/threats identified in the facility HVA)
Appendix A: Active Shooter
Appendix B: Biological Event
Appendix C: Bomb Threat
Appendix D: Chemical Event
Appendix E: Cyber Attack
Appendix F: Earthquake
Appendix G: Explosive Event
Appendix H: Extended Power Outages
Appendix I: Fire
Appendix J: Floods
Appendix K: Hazardous Materials and Decontamination
Appendix L: Hurricanes
Appendix M: Nuclear/Radioactive Event
Appendix N: Pandemic Influenza/Infection Control/Isolation
Appendix O: Severe Weather/Extreme Temperatures/Winter Storms
Appendix P: Surge Capacity
Appendix Q: Wildfire
83
Appendix A: Active Shooter
An active shooter is an individual actively engaged in killing or attempting to kill people in a confined and/or populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims. Active shooter situations are unpredictable and evolve quickly. Typically, the immediate deployment of law enforcement is required to stop the shooting and mitigate harm to victims. Because active shooter situations are often over within ten to fifteen minutes, before law enforcement arrives on the scene, individuals must be prepared both mentally and physically to deal with an active shooter situation. This annex is designed to minimize the negative impacts and to provide an appropriate response in the event of an incident involving a person with a weapon within the facility.
Include the organizational plan for an active shooter event.
Planning considerations:
Contact response partners Intercom codes Facility Lockdown Policy Facility “Go Box” (map of facility, keys, etc.)
Links:
http://www.dhs.gov/publication/active-shooter-how-to-respond
http://training.fema.gov/is/courseoverview.aspx?code=IS-907
84
Appendix B: Biological Event
A biological event is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. These agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment. Biological agents can be spread through the air, through water, or in food.
Terrorists may use biological agents because they can be extremely difficult to detect and do not cause illness for several hours to several days. Some bioterrorism agents, such as the smallpox virus, can be spread from person to person and some, such as anthrax, cannot.
Include the organizational plan for a biological event.
Planning efforts need to be made for these specific biological attacks: Aerosol Anthrax, Plague, Food Contamination, and Foreign Animal Disease.
Planning considerations:
Contact response partners Shut down heating, ventilation, and air conditioning Personal Protection Equipment Plan/training Infection Control Plan Isolation/Quarantine Plan Food Safety Plan Treatment Plan Decontamination procedures Negative pressure room
Links:
http://www.fema.gov/pdf/emergency/nrf/nrf_BiologicalIncidentAnnex.pdf
http://www.ready.gov/sites/default/files/documents/files/biological.pdf
http://www.dhs.gov/topic/biological-security
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4904a1.htm
85
Appendix C: Bomb Threat
A bomb threat can be delivered as either a written or verbal notification of intent to detonate an explosive or incendiary device with the intent of causing harm to individuals or of causing damage to or the destruction of physical property. Such a device may or may not exist. While a good number of bomb threats are pranks, bomb threats made in connection with other crimes such as extortion, hijacking, and robbery are quite serious.
Include the organizational plan for a bomb threat.
Planning considerations:
Contact response partners Intercom codes Bomb Threat Call Checklist Facility Lockdown Policy Evacuation Decision Maker(s) with contact information Evacuation with meeting locations identified Search procedures for each department Train staff on awareness of suspicious packages
Link:
https://emilms.fema.gov/is906/assets/ocso-bomb_threat_samepage-brochure.pdf
86
Appendix D: Chemical Event
A chemical event is the intentional use of toxic chemicals to inflict mass casualties and mayhem on an unsuspecting civilian population.
Chemical terrorism often refers to the use of military chemical weapons that have been illicitly obtained or manufactured de novo. However, a chemical event could also be an accidental release such as the unintentional explosion of an industrial chemical factory, a tanker car, or a transport truck in proximity to a civilian residential community, school, or worksite.
Include the organizational plan for a chemical event.
Planning efforts need to be made for these specific chemical attacks: Blister Agent, Toxic Industrial Chemicals, Nerve Agent, and Chlorine Tank Explosion.
Planning considerations:
Contact response partners Intercom codes Shut down heating, ventilation, and air conditioning Decontamination procedures
Links:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4904a1.htm
87
Appendix E: Cyber Attack
Cyber security involves protecting an infrastructure by preventing, detecting, and responding to cyber incidents. Unlike physical threats that prompt immediate action, such as stop, drop, and roll in the event of a fire, cyber threats are often difficult to identify and comprehend. Among these dangers are viruses erasing entire systems, intruders breaking into systems and altering files, intruders using your computer or device to attack others, or intruders stealing confidential information. The spectrum of cyber risks is limitless. Threats, some more serious and sophisticated than others, can have wide-ranging effects on the individual, community, organizational, and national level.
Include the organizational plan for a cyber attack.
Planning considerations:
Policies and procedures for employee use of your organization’s information technologies
Procedures for securing all computer equipment and servers with specific individual access permissions
Procedures to report lost items for employees Procedures to prevent unauthorized data transfer via USB drives (flash drives or
thumb drives) and other portable devices Policies and procedures to disable inactive accounts, including those of
transferred or terminated employees, after a set time period Procedures on how to address potential cyber security vulnerabilities with
medical devices
Links:
http://www.ready.gov/cyber-attack
http://www.fema.gov/pdf/government/grant/hsgp/fy09_hsgp_cyber.pdf
http://www.ready.gov/document/common-sense-guide-cyber-security-small-businesses
http://www.phe.gov/Preparedness/planning/cip/Documents/cybersecurity-checklist.pdf
88
Appendix F: Earthquake
Earthquakes are among the most unpredictable and devastating of natural disasters. An earthquake can be defined as a sudden movement of the earth as the result of the abrupt release of pressure. This release of pressure can result at fault lines where two tectonic plates collide or separate; it can occur as the ground lifts or sinks due to underlying pressures, or pressure can be released in thrust faults or folded rock. An earthquake is also referred to as a “shaking hazard.”
Include the organizational plan for an earthquake.
Planning considerations:
Contact response partners Evacuation with meeting locations identified Procedures for utility shut down Medical surge (if applicable) Mass fatality and casualty
Links:
http://www.fema.gov/pdf/plan/prevent/rms/396/fema396_a.pdf
http://www.ready.gov/earthquakes
89
Appendix G: Explosive Event
An unintentional explosion can result from a gas leak in the presence of an ignition source. These leaks/explosions can occur in building lines, infrastructure pipelines, or transportation. The principal explosive gases are natural gas, methane, propane, and butane, because they are widely used for heating purposes. However, many other gases, like hydrogen and acetylene, are combustible and have caused explosions in the past. Gas explosions can be prevented with the use of intrinsic safety procedures to prevent ignition.
Improvised Explosive Devices, commonly referred to as IEDs, have become common tools of domestic and international terrorists. According to the Agency for Healthcare Research and Quality (AHRQ), due to the public accessibility of explosive materials and bomb-making knowledge, a domestic terrorist attack would probably take the form of a conventional explosive munitions attack. An explosive device may consist of explosives alone or may be combined with biological, chemical, or radiological materials. The AHRQ states that a “lack of knowledge about primary blast injuries and failure to recognize a blast’s effect on certain organs can result in additional morbidity and mortality.”
Include the organizational plan for an explosive event.
Planning efforts need to be made for these specific explosive attacks: Gas Leak/Explosion, and IEDs.
Planning considerations:
Contact response partners Intercom codes Mass fatality and casualty Medical surge Blast injuries Secondary devices Shut down heating, ventilation, air conditioning, power, oxygen, and gas to
affected area(s) Close doors and windows Evacuation with meeting locations identified Fire extinguishers (types, location, and training) Smoke detector locations Sprinkler systems Disaster Resiliency and National Fire Protection Association (NFPA) Codes
and Standardso Refer to the NFPA Standards in NFPA 101 Life Safety Code, and NFPA
1600, Disaster/Emergency Management and Business Continuity Programs
90
Links:
http://www.dhs.gov/topic/explosives
http://www.ready.gov/explosions
http://m.fema.gov/explosions
https://www.osha.gov/SLTC/etools/hospital/hazards/fire/fire.html
http://www.nfpa.org/safety-information/for-consumers/escape-planning/basic-fire-escape-planning
91
Appendix H: Extended Power Outages
Extended loss of electrical services can be fatal for a frail and compromised population in a healthcare facility. While the occasional interruption of the electrical utility grid is part of life, steps need to be taken to protect vulnerable patients during times of any loss of power. Utility service can be interrupted by natural disasters, industrial accidents at power generation facilities, or damage to power transmission systems.
Include the organizational plan for extended power outages.
Planning considerations:
Contact response partners External Contacts (Power Company, electrical contractors, etc.) Evaluation of patients for hypothermia/hyperthermia
Links:
http://www.phe.gov/Preparedness/planning/cip/Documents/healthcare-energy.pdf
http://www.acphd.org/media/269431/electical%20power%20outage_loss%20response%20plan.ww.pdf
http://www.ready.gov/power-outage
92
Appendix I: Fire
Fire is a rapid oxidation process that releases energy in varying intensities in the form of heat and often light, and generally creates and releases toxic vapors. Fire does not have to be in immediate proximity to be fatal. The reduced oxygen and production of smoke and fumes can replace breathable air, creating an anaerobic environment that leads to asphyxiation. Not all fires create visible smoke. Inside a building where airflow is restricted, the risk of dying from oxygen starvation is greatly increased.
Include the organizational plan for fire.
Planning considerations:
Contact response partners Intercom codes Shut down heating, ventilation, air conditioning, power, oxygen, and gas to
affected area(s) Close doors and windows Evacuation with meeting locations identified Fire extinguishers (types, location and training) Smoke detector locations Sprinkler systems Disaster Resiliency and National Fire Protection Association (NFPA) Codes and
Standardso Refer to the NFPA Standards in NFPA 101 Life Safety Code, and NFPA 1600,
Disaster/Emergency Management and Business Continuity Programs
Links:
https://www.osha.gov/SLTC/etools/hospital/hazards/fire/fire.html
http://www.nfpa.org/safety-information/for-consumers/escape-planning/basic-fire-escape-planning
93
Appendix J: Floods
Floods are one of the most common hazards in the United States. A flood is the inundation of a normally dry area caused by an increased water level in an established watercourse. Flood effects can be local, impacting a neighborhood or community, or very large, affecting entire basins and multiple states. Flooding can also occur along coastal areas as a result of abnormally high tides, storms, and high winds.
Include the organizational plan for floods.
Planning considerations:
Contact response partners Intercom codes Internal and external flooding Shut down power to affected area(s) Evacuation with meeting locations identified Monitor weather radio and media outlets
Links:
http://www.ready.gov/floods
https://www.osha.gov/dts/weather/flood/index.html
94
Appendix K: Hazardous Materials and Decontamination
Hazardous Materials incidents occur when a hazardous substance has been dispersed into the environment in a manner that has the potential to harm people. These emergencies can result from the release of toxic substances in any quantity, the release of large quantities of a substance that is not problematic when used in smaller and controlled amounts, or from the results of combining two otherwise non-hazardous substances. Release can be in vapor, aerosol, liquid, or solid form.
Include the organizational plan for hazardous materials and decontamination.
Planning considerations:
Contact response partners Intercom codes Identify sources of hazardous materials/waste Decontamination Plan Runoff of contaminated water during decontamination Identify necessary emergency actions to save lives and protect the staff and the
environment Evacuation with meeting locations identified Identify exposure procedures Infection Control Plan
Links:
http://www.ready.gov/hazardous-materials-incidents
https://www.osha.gov/SLTC/hazardouswaste/training/decon.html
95
Appendix L: Hurricanes
A tropical cyclone, also called a hurricane depending on its location and strength, is a storm system characterized by winds reaching a constant speed of at least 74 miles per hour and possibly exceeding 200 miles per hour. On average, a hurricane’s spiral clouds cover an area several hundred miles in diameter. The spirals are heavy cloud bands from which torrential rains fall. Tornado activity may also be generated from these spiral cloud bands. Hurricanes are unique in that the vortex or eye of the storm is deceptively calm and almost free of clouds with very light winds and warm temperatures. Outside the eye, a hurricane’s counter-clockwise winds bring destruction and death to coastlands and islands in its erratic path. High winds and heavy rains from hurricanes impact inland regions many miles from the coast.
Include the organizational plan for tropical cyclones.
Planning considerations:
Contact response partners Storm surge zones Hurricane evacuation routes Evaluation of patients for discharge/transfer Evacuation Plan Transfer agreements and transportation Staffing needs Resources and Assets Utilities and Supplies Shelter in Place Plan (if applicable) Monitor weather radio and media outlets Influx of patients Reference Severe Weather Plan
Links:
http://www.ready.gov/hurricanes
http://emergency.cdc.gov/disasters/hurricanes/index.asp
http://www.nws.noaa.gov/om/hurricane/index.shtml
96
Appendix M: Nuclear/Radioactive Event
While nuclear power facilities have multiple mechanical, technological, and procedural redundancies to minimize technological failure and human error, it is prudent to have a plan for dealing with the possibility of a catastrophic failure at a nuclear facility or threat of an act of terrorism. Likewise, radiological events occur without warning and will require rapid responses to decontaminate and treat those who may have been exposed.
Include the organizational plan for nuclear and radiological events.
Planning efforts need to be made for these specific nuclear and radiological events: Radiological Dispersal Device, Nuclear Detonation, and Nuclear Accident.
Planning considerations:
Contact response partners Intercom codes Proximity to nuclear facility (plume projections) Evacuation with meeting locations identified Identify exposure procedures Decontamination Plan Identify necessary emergency actions to save lives and protect the staff Nuclear medicine
Links:
http://www.ready.gov/nuclear-power-plants
http://www.ready.gov/nuclear-blast
http://www.ready.gov/radiological-dispersion-device-rdd
http://www.remm.nlm.gov/
97
Appendix N: Pandemic Influenza/Infection Control/Isolation
A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza virus emerges for which people have little or no immunity and for which there is no vaccine. The disease spreads easily from person to person, causes serious illness, and can sweep across the country and around the world in a very short time. It is expected that such an event could overwhelm local healthcare systems as an increased number of sick individuals seek healthcare services. In addition, the number of healthcare workers available to respond to these increased demands will be reduced by illness rates similar to pandemic influenza attack rates affecting the rest of the population.
Include the organizational plan for pandemic influenza/infection control/isolation.
Planning considerations:
Contact response partners Infection Control Plan Isolation Plan Immunization Policy Preventative measures (e.g., personal protective equipment, hand sanitizer) Staff absenteeism due to illness
Links:
http://www.flu.gov/
http://www.ready.gov/pandemic
http://www.cdc.gov/flu/pandemic-resources/index.htm
98
Appendix O: Severe Weather/Extreme Temperatures/Winter Storms
Severe Weather
Severe weather is any atmospheric phenomenon that can cause property damage or physical harm.
Extreme Temperatures
The loss of the heating, ventilation, and air conditioning (HVAC) system in a healthcare facility is a serious technological failure, under certain conditions. During times of extreme weather, such as a frigid cold winter or unusually hot summer, the failure of these systems can create harmful and fatal conditions for patients.
Winter Storms
Snow and accompanying ice can immobilize a region and paralyze a city. Ice can bring down trees and break utility poles, disrupting communications and utility service. It can also immobilize ground and air transportation. The healthcare facility may find itself completely on its own for several days.
Include the organizational plan for severe weather/extreme temperatures/winter storms.
Planning considerations:
Contact response partners Communications Utilities and Supplies Loss of HVAC Identify necessary emergency actions to save lives and protect the staff Evaluation of patients for hypothermia/hyperthermia Monitor weather radio and media outlets Severe Weather
o Hailo Intense cloud to ground lightningo Torrential raino Strong winds (micro-bursts, straight line winds)o Tornadoeso Extreme cold and heato Ice and snow
99
Links:
http://www.ready.gov/severe-weather
http://www.ready.gov/tornadoes
http://www.ready.gov/heat
http://www.ready.gov/winter-weather
100
Appendix P: Surge Capacity
Surge capacity is a measurable representation of a healthcare system's ability to manage a sudden or rapidly progressive influx of patients within the currently available resources at a given point in time. Healthcare systems must develop and maintain surge capacity throughout the system in anticipation of the need to care for patients presenting from infectious disease outbreaks, public health emergencies, and mass casualty incidents.
Include the organizational plan for surge capacity including alternate on-site triage and treatment locations.
Planning considerations:
Contact response partners Intercom codes Alternate triage options during a mass casualty event Variations of casualty events Staffing needs Equipment and supplies Evaluation of patients for discharge/transfer
Links:
http://archive.ahrq.gov/news/ulp/btbriefs/btbrief3.htm
http://www.phe.gov/Preparedness/planning/mscc/handbook/Documents/mscc080626.pdf
101
Appendix Q: Wildfire
Each year, thousands of acres of land and dozens of structures are destroyed by fires that can start at any time of the year. Wildfires have a variety of causes including arson, lightning, debris burning, and carelessly discarded cigarette butts. Adding to the fire hazard is the growing number of people living in new communities built in areas that were once open land.
Include the organizational plan for wildfire.
Planning considerations:
Contact response partners Intercom codes Shut down heating, ventilation, and air conditioning Close doors and windows Smoke (inhalation, visibility) Evacuation with meeting locations identified
Links:
http://www.ready.gov/wildfires
https://www.osha.gov/dts/wildfires/index.html
http://www.readyforwildfire.org/wildfire_action_plan
102
Related Documents
